Clinical Coding Education Manager

CORE RESPONSIBILITIES:

• Risk Adjustment
  • Develops, manages, implements, and supports risk Adjustment programs and manages Risk Adjustment related activities.
  • Evaluates risks and outcomes associated with Risk Adjustment Program goals and objectives and escalating issues to the Director of Compliance, as appropriate.
  • Supports key objectives designed to build and strengthen patient care delivery and Risk Adjustment documentation and reporting capabilities, as well as driving continuous improvement efforts.
  • Coordinates with Business Intelligence on analytics and data submissions to insurances and vendors as determined in InterMed Contracts.
  • Responsible for outcomes payer projects related to risk adjustment validation and recapture including pre-visit chart review procedures, post-claims review and audit and supplemental data procurement processes related to risk adjustment.
  • Represents InterMed in collaboration with Insurance Representatives.
• Education
  • Designs and implements education plans for physicians, Advanced Practice Providers (APPs) and staff related to coding and risk adjustment coding based on audit results and organizational initiatives and goals.
  • Serves as subject matter expert in coding requirements related to new service lines, departments and procedures. Consults with Practice Managers, Billing and Finance, IT and eCW teams to ensure compliance and documentation requirements are met for new services.
• Coding Compliance
  • Develops audit plans based on annual coding compliance plan, coding guideline changes, coding trends and OIG work plan. Determines audit scope, presents audit findings to physicians, committees and leadership. Creates and monitors corrective action plans per coding compliance plan.
  • Evaluates and prioritizes coding and other audits/reviews and subsequent education based on changing guidelines, previous results/trends and InterMed Policy and procedures and supervises Coding Education Specialists.
  • Audits and reviews documentation compared to InterMed Policies, coding guidelines, payer and compliance rules.
  • Researches and summarizes rules, statutes and regulations related to compliance, coding and documentation and incorporates findings into recommendations, InterMed Policies and educational materials.
  • Responsible for defining and maintaining the integrity of coding audit and coding query processes for coding education and CDIS teams at InterMed.
  • Works collaboratively with Physicians, APPs, Practice and Clinical Managers, Billing, Finance, Information Technology and Business intelligence teams to ensure coding compliance and accuracy.
• Supervision
  • Sets clear accuracy measures and productivity goals for the CDI and Coding Education teams; monitors progress to achieve results in accordance with InterMed Strategic goals.
  • Responsible for hiring, training, managing & evaluating team performance and conducting professional development plans.
• Leadership Competencies
  • Personnel Management
    • Overall accountability and management of staff.
    • Regularly assess developmental opportunities for staff, coach staff to enhance performance, and support staff in learning and applying new skills and competencies.
    • Coordinate and monitor staffing levels and labor efficiency.
    • Approver for staff payroll biweekly in accordance with payroll department guidelines and schedule.
    • Mentors and counsels’ staff to include initiating Performance Improvement plans.
    • Works with the Compliance and Human Resources teams to assure compliance with State, Federal and OSHA (Occupational Safety and Health Administration) requirements for staff.
  • Leadership
    • Models behaviors that demonstrate service excellence to staff and focus on the patient as the primary customer.
    • Leads Lean Six Sigma initiatives for the department to foster a culture of continuous improvement.
    • Fosters intra-departmental support and collaboration between all sites.
    • Monitors department performance and creatively seeks solutions to foster quality improvement.
    • Develop and maintain an open and effective line of communication with employees.
  • Communication
    • Works in partnership with the clinical teams, practice leadership, and senior leadership teams.
    • Fosters strong working relationships with all levels of the organization to facilitate effective communication and to connect front line staff’s daily priorities to the organization’s strategic goals.
    • Demonstrates strong interpersonal savvy.
  • Strategic Planning and Program Coordination
    • Assess current state of department with relation to existing InterMed goals and plans.
    • Develops proactive plans to ensure InterMed’s positioning as a leader in healthcare in alignment with company KPIs.
    • Monitors budgets to identify potential financial overruns and variances; makes appropriate recommendations to alleviate financial implications.
    • Champions interdepartmental problem solving.
    • Ensures appropriate departmental policy development and adherence.
  • Confidentiality
    • Demonstrate knowledge and understanding of patient privacy rights under HIPAA (Health Insurance Portability and Accountability) guidelines. Maintain confidentiality related to financial, or other sensitive materials and information in printed, electronic, or verbal form, which may jeopardize the privacy of patients and/or employees. Accesses and uses the minimum necessary patient identifiable information to perform job responsibilities and duties and only for authorized purposes.
  • Maintains strict confidentiality in alignment with HIPAA (Health Insurance Portability and Accountability) guidelines and InterMed policies.
  • Perform other duties to support the mission, vision and values of InterMed.

MISSION AND VALUES:

• Follows InterMed’s mission to provide patient-centered primary care, putting the patient first to deliver high quality, high value care.
• Provide the highest quality care to our patients with a level of service that exceeds their expectations.
• Maintain a positive attitude and always treat our patients and each other with dignity and respect.
• Insist on honesty and integrity from each other and our business partners.
• Make teamwork a core component of our relationships between physicians, staff, and patients.
• Embrace change to better serve our patients.
• Use business practices that feature individual accountability and group responsibility to ensure delivery of high value healthcare.
• Have fun as we carry out our mission to serve.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Education:
  • Bachelor’s Degree Preferred, Business or Healthcare degree preferred.
• Experience:
  • At least four years clinical experience required.
  • At least four years of revenue cycle experience required
• License/Certifications:
  • Active, unencumbered Maine RN license and Certified Professional Coder (CPC) and Certified Risk Adjustment Coder (CRC) certification required.
  • Certified Officer of Compliance (COC) preferred
• Must have working knowledge of the revenue cycle.
• Must have in-depth knowledge of billing, coding, insurance practices, ACO contracts and the ‘language’ associated with each.
• Excellent written and verbal communication skills and must be able to communicate effectively to all levels of the organization.

InterMed is an equal opportunity workplace and prohibits discrimination or harassment of any kind. We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, gender identity and/or expression, sexual orientation, marital status, disability, veteran status, or any other basis protected by applicable federal, state or local law.